The Author Replies

Excerpt

To the Editor—We thank Dr. Altomare for his letter. Because we analyzed only patients who underwent operative treatment, the number of patients treated conservatively is unknown. The large number of patients with Grade I and II hemorrhoids may be explained as follows: more than one-half of these patients (160/282) were referred directly for surgery by independent gastroenterologists, presumably because they had failed or were not eligible for conservative treatment. Another 28 patients had significant associated anal skin tags, 19 had a recurrence after previous treatment, 15 had an acute thrombosis, and 8 had severe bleeding. The surgeon evaluated each patient on the day before surgery and confirmed the need for an operation. Accordingly, we do not believe that patients were overtreated or that unnecessary surgery was performed. …