A controlled trial comparing emergency hemorrhoidectomy versus conservative treatment for acutely thrombosed hemorrhoid

Aim: Acutely thrombosed hemorrhoid is either treated conservatively or with emergency hemorrhoidectomy. The treatments have not been compared in a randomized controlled trial. We aim to investigate the relative effectiveness and safety of the two modes of treatment.Methods: We performed a randomized controlled trial at the United Christian Hospital. Patients with acutely thrombosed hemorrhoids were randomized to either conservative management or emergency hemorrhoidectomy. The primary outcome was the number of days to halve the visual analog pain score (VAS). Secondary outcomes included VAS on follow‐up, early and late functional status, total analgesic requirment, days off work and complication rate.Results: Forty‐six patients entered the trial between June 2000 and October 2001. Twenty‐three were randomized to each group. Demographic variables were similar for both groups, so was VAS on admission. The number of days taken to halve the VAS was significantly shorter after emergency hemorrhoidectomy (2.5 vs 4.2 days, P=0.001). VAS at days 14, 21, 28 were similar between the groups. The functional status (mobilization and sitting, defecatory pain) at days 3, 6, 14, 21 and 28 were also similar. Analgesic requirements and days off work were similar. There was no complication after emergency hemorrhoidectomy. After resolution, nine patients (45%) of the conservative group required hemorrhoidectomy for persistent symptoms.Conclusion: Emergency hemorrhoidectomy relieves pain faster than conservative management. It is safe and has similar functional results as conservative management. Emergency hemorrhoidectomy is therefore the treatment of choice.