title: [Practical Implementation of the "Four-column Concept" in the Situation-Adjusted Therapy for Haemorrhoidal Disease in the Daily Routine of a Proctology Department].
abstract: BACKGROUND
  In addition to the stage, several factors influence the treatment of haemorrhoids. The aim of this study was the elaboration of an individual therapy concept which is situation-adjusted. In this context, our own experience and approaches are presented.
  
  
  METHODS
  In the Department of Coloproctology of the Prosper-Hospital Recklinghausen, from January 2009 to August 2012, 903 haemorrhoidectomies (2nd to 4th degree) have been performed. We report our results on the practical implementation of a situation-adjusted treatment of haemorrhoidal disease. In this context we present an overview of effective modifications of surgical techniques. Retrospectively the perioperative course and postoperative outcome were evaluated.
  
  
  RESULTS
  Even in a collective with a large number of high-risk patients (26 %) respecting the "four columns" that constitute the fundament of a situation-adjusted treatment of haemorrhoids, high patient satisfaction and good outcome with low complication (7 %) and recurrence (0 %) rates could be attained.
  
  
  CONCLUSIONS
  The "four columns" (findings of examination, therapeutic options, physician and patient) form the fundament of an effective treatment of haemorrhoidal disease without many complications and guarantee an individually tailored therapy for each patient.
authors.affiliation: Abteilung für Koloproktologie, Prosper-Hospital, Recklinghausen, Deutschland.
authors.forename: S
authors.initials: S
authors.lastname: Kersting
authors.affiliation: Abteilung für Koloproktologie, Prosper-Hospital, Recklinghausen, Deutschland.
authors.forename: E
authors.initials: E
authors.lastname: Berg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000601:surgery; D005858:Germany; D061865:Hemorrhoidectomy / Q000379:methods*; D006484:Hemorrhoids / Q000145:classification / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods; D011183:Postoperative Complications / Q000209:etiology; D012008:Recurrence; D012307:Risk Factors; D055815:Young Adult