Summary Recommendations

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PROSPECT Haemorrhoid Surgery Subgroup

For each review, a Subgroup of the prospect Working Group performs an initial evaluation of the evidence and also drafts clinical practice statements and recommendations, which are then discussed by the whole Working Group before a final consensus is reached. The Subgroup may sometimes include a non-Working Group member, to provide additional expertise in the procedure being reviewed. For the haemorrhoid surgery review, the Subgroup members were:

Professor Girish Joshi (PROSPECT Working Group member)

Professor Edmund Neugebauer (PROSPECT Working Group member)

Grades of Recommendation

Recommendations are graded according to the overall level of evidence (LoE) on which the recommendations are based, which is determined by the quality and source of evidence:

Levels of evidence and grades of recommendation in PROSPECT reviews (from 2006)

PROSPECT provides clinicians with supporting arguments for and against the use of various interventions in postoperative pain based on published evidence and expert opinion. Clinicians must make judgements based upon the clinical circumstances and local regulations. At all times, local prescribing information for the drugs referred to must be consulted.

Summary Recommendations

Pre-, intra- and postoperative interventions have been evaluated for the management of postoperative pain following haemorrhoid surgery. Unless otherwise stated, ‘pre-operative’ refers to interventions applied before surgical incision, ‘intra-operative’ refers to interventions applied after incision and before wound closure, ‘postoperative’ refers to interventions applied at or after wound closure. After haemorrhoid surgery, pain is not only related to the early postoperative period, but is also a problem after 2–3 days, around the time of first defecation. The following peri-operative interventions for haemorrhoid surgery have been reviewed:

Pre-operative recommendations for Haemorrhoid Surgery

Intra-operative recommendations for Haemorrhoid Surgery

Postoperative recommendations for Haemorrhoid Surgery

Not recommended for Haemorrhoid Surgery

See Overall PROSPECT recommendations for the overall strategy for managing pain after haemorrhoid surgery.