TY - JOUR
T1 - Hemorrhoidectomy and Excision of Skin Tags in IBD
T2 - Harbinger of Doom or Simply a Disease Running Its Course?
AU - McKenna, Nicholas P.
AU - Lightner, Amy L.
AU - Habermann, Elizabeth B.
AU - Mathis, Kellie L.
N1 - Funding Information:
Funding/Support: This work has been supported indirectly by the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery and by the Mayo School of Graduate Medical Education Clinician Investigator program. No specific grant number is associated with the work.
Publisher Copyright:
© The American Society of Colon & Rectal Surgeons, Inc.
PY - 2019/12/1
Y1 - 2019/12/1
N2 - BACKGROUND: Controversy in performing hemorrhoidectomy and anal skin tag excision in patients with IBD stems from dated reports of nonhealing wounds resulting in proctectomy. OBJECTIVE: This study aimed to determine the safety of interventional management of hemorrhoids or anal skin tags in patients with Crohn's disease or ulcerative colitis. DESIGN: This study is a retrospective review of patient records from 2000 to 2017. SETTING: The patient records were retrieved from a multistate health system. PATIENTS: Adult patients with IBD undergoing interventional management of hemorrhoids or skin tags were included. MAIN OUTCOME MEASURE: The primary outcome measured was the long-Term requirement of proctectomy. RESULTS: Ninety-seven patients (n = 49 Crohn's disease, 48 ulcerative colitis) underwent interventional management of hemorrhoids or anal skin tags (n =35 rubber band ligation, 27 anal skin tag excision, 21 hemorrhoidectomy, 14 excision/incision of thrombosed hemorrhoid). Thirty-day complications were observed in 5 patients (n = 4 urinary retention, 1 perianal abscess). Five patients with Crohn's disease eventually required proctectomy at a median of 7 years after skin tag excision (range, 6 months to 10 years), but none were secondary to impaired wound healing. Two patients with ulcerative colitis who had previously undergone IPAA were subsequently diagnosed with Crohn's disease of the pouch after skin tag excision. No other long-Term complications were seen in patients with ulcerative colitis. LIMITATIONS: The study's retrospective design does not allow identification of patients with IBD who underwent only medical management of their hemorrhoids. There is also selection bias in which patients were selected for interventional management of their disease. CONCLUSIONS: The requirement for proctectomy after hemorrhoidectomy/skin tag excision appears to be secondary to the natural disease course of perianal Crohn's disease rather than perianal intervention. Selective hemorrhoidectomy and skin tag excision in patients with well-controlled luminal disease should be considered. See Video Abstract at http://links.lww.com/DCR/B55.
AB - BACKGROUND: Controversy in performing hemorrhoidectomy and anal skin tag excision in patients with IBD stems from dated reports of nonhealing wounds resulting in proctectomy. OBJECTIVE: This study aimed to determine the safety of interventional management of hemorrhoids or anal skin tags in patients with Crohn's disease or ulcerative colitis. DESIGN: This study is a retrospective review of patient records from 2000 to 2017. SETTING: The patient records were retrieved from a multistate health system. PATIENTS: Adult patients with IBD undergoing interventional management of hemorrhoids or skin tags were included. MAIN OUTCOME MEASURE: The primary outcome measured was the long-Term requirement of proctectomy. RESULTS: Ninety-seven patients (n = 49 Crohn's disease, 48 ulcerative colitis) underwent interventional management of hemorrhoids or anal skin tags (n =35 rubber band ligation, 27 anal skin tag excision, 21 hemorrhoidectomy, 14 excision/incision of thrombosed hemorrhoid). Thirty-day complications were observed in 5 patients (n = 4 urinary retention, 1 perianal abscess). Five patients with Crohn's disease eventually required proctectomy at a median of 7 years after skin tag excision (range, 6 months to 10 years), but none were secondary to impaired wound healing. Two patients with ulcerative colitis who had previously undergone IPAA were subsequently diagnosed with Crohn's disease of the pouch after skin tag excision. No other long-Term complications were seen in patients with ulcerative colitis. LIMITATIONS: The study's retrospective design does not allow identification of patients with IBD who underwent only medical management of their hemorrhoids. There is also selection bias in which patients were selected for interventional management of their disease. CONCLUSIONS: The requirement for proctectomy after hemorrhoidectomy/skin tag excision appears to be secondary to the natural disease course of perianal Crohn's disease rather than perianal intervention. Selective hemorrhoidectomy and skin tag excision in patients with well-controlled luminal disease should be considered. See Video Abstract at http://links.lww.com/DCR/B55.
KW - Hemorrhoidectomy
KW - Hemorrhoids
KW - Inflammatory bowel disease
KW - Skin tags
UR - http://www.scopus.com/inward/record.url?scp=85075089575&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85075089575&partnerID=8YFLogxK
U2 - 10.1097/DCR.0000000000001524
DO - 10.1097/DCR.0000000000001524
M3 - Article
C2 - 31580261
AN - SCOPUS:85075089575
SN - 0012-3706
VL - 62
SP - 1505
EP - 1511
JO - Diseases of the colon and rectum
JF - Diseases of the colon and rectum
IS - 12
ER -