1.Patient-reported outcomes after hemorrhoid surgery: early results from a prospective, nationwide, real-world, cohort study on diverse approaches
Metin KEMENT ; Atıf TEKIN ; Hakan BAYSAL ; Salih TOSUN ; Orhan ALIMOĞLU ; İlker SÜCÜLLÜ ; Osman CIVIL ; Nevin SAKOĞLU ; Naciye Çiğdem ARSLAN ; Cihad TATAR ; Ali Emre NAYCI ; Aziz ARI ; Ensar ÇAKIR ; Rozan KAYA ; İlknur TURAN ; Taygun GÜLŞEN ; Serhat MERIÇ ; Erkan YAVUZ ; Nihat BUĞDAYCI ; Farid Mohamad HAMAD ; Sezai LEVENTOĞLU ; Ramazan KOZAN ; Özkan AKPINAR ; Hakan YANAR ; Fatih YANAR ; Hasan Fehmi KÜÇÜK ; Mehmet KARAHAN ; Selçuk KAYA ; Nail Can ADIGÜZEL ; Tolga ÖNDER ; İlker ABCI ; Ahmet Zeki AYDIN ; Ömer Faruk ÖZKAN ; Nurhilal KIZILTOPRAK ; Berkay ÖZCAN ; Anıl ORHAN ; Alp Ömer CANTÜRK ; Murat TAN ; Yusuf BILGIN ; Harun ÇOK ; Azamet CEZIT ; Mehmet Mahir FERSAHOĞLU ; Mustafa ÖNCEL
Annals of Coloproctology 2025;41(6):573-585
Purpose:
Real-world evidence comparing surgical techniques for symptomatic hemorrhoidal disease (HD) remains limited, despite the availability of multiple approaches. This study aimed to evaluate short-term, interim outcomes from a prospective, nationwide cohort study that compared the effectiveness of different operative techniques based on patient-reported outcome measures (PROMs) in patients with symptomatic HD.
Methods:
A prospective, nationwide cohort study was conducted at 20 tertiary care centers across Turkiye between July 2022 and July 2024. Adult patients aged 18 years or older with symptomatic HD (grades I–IV) who underwent surgery during this period were included. The choice of procedure was determined by the operating surgeon, and patients were categorized into excisional, fixative, and ablative groups according to the surgical approach used. The primary outcomes were changes in the Hemorrhoidal Disease Symptom Score, Short Health ScaleHD, visual analog scale for pain, and patient satisfaction, assessed from the preoperative period to postoperative day 7 and postoperative week 6.
Results:
The study included a total of 315 patients after excluding those who did not fulfil the inclusion criteria. Among them, 239 (78.9%) were male, with a mean age of 43.7±11.7 years. The distribution of patients across surgical groups was 207 (65.7%) in the excisional group, 30 (9.5%) in the fixative group, and 78 (24.8%) in the ablative group. All groups demonstrated significant improvements in PROM scores from preoperative to postoperative assessments. However, no statistically significant differences were observed between groups at any time point for PROM scores or for changes in PROM scores across consecutive evaluations (P≥0.05 for all comparisons). Urinary retention occurred more frequently, and hospital stays were longer in the fixative group (P=0.006 and P<0.001, respectively). The excisional group had a greater need for narcotic use and longer duration of use (P=0.003 and P<0.001, respectively).
Conclusion
This real-world cohort study shows that all 3 surgical approaches are effective for HD, providing comparable short-term symptomatic relief and patient satisfaction. These techniques appear equally valid treatment options, and the choice of procedure may best be individualized based on patient-specific characteristics and surgeon preference.Trial registration: ClinicalTrials.gov identifier: NCT05429060
Result Analysis
Print
Save
E-mail