Anal vein thrombosis—excise or nothing

The recurrence rates of excision, incision, and conservative treatments following anal vein thrombosis (AVT) are unclear. We compared the efficacy of treatment methods using Kaplan–Meier statistics. Our null hypothesis H0 is that incision of AVT gives as good results as surgical excision in terms of recurrence-free outcome. One hundred fifty patients treated in a single hospital in northern Germany from 2013 to 2017 were interviewed and their data analysed. While recurrence-free outcome was about 22% following conservative treatment and 21% for incisional treatment, only surgical excision enabled recurrence-free outcome (86%) 4 years following surgery. While conservative and incisional therapy did not differ statistically, excision was significantly better than both of those treatments (p < 0.001). Our null hypothesis H0 that incision of AVT gives as good results as surgical excision in terms of recurrence free outcome was rejected. Incision of AVT should be abandoned, as it is painful, useless, and associated with a high recurrence rate as a conservative treatment in four of five patients. Surgical excision is the only method that enables significant recurrence-free outcome and should be used as the treatment of choice.