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Review

Surgical Management of Hemorrhoidal Disease in Inflammatory Bowel Disease: A Systematic Review with Proportional Meta-Analysis

1
II Surgery Unit, Regional Hospital Treviso, AULSS2, 31100 Treviso, Italy
2
Department of Surgery, Oncology and Gastroenterology-DISCOG, University of Padua, 35128 Padua, Italy
3
Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, 53100 Siena, Italy
4
Statistics Division, The George Institute for Global Health, University of New South Wales, Sydney 2042, Australia
5
Department of Advanced Biomedical Sciences, ‘Federico II’ University of Naples, 80131 Naples, Italy
6
Department of Medicine-DIMED, University of Padua, 35128 Padua, Italy
*
Author to whom correspondence should be addressed.
Joint first authors.
Joint senior authors.
Academic Editor: Hidekazu Suzuki
J. Clin. Med. 2022, 11(3), 709; https://doi.org/10.3390/jcm11030709
Received: 27 December 2021 / Revised: 25 January 2022 / Accepted: 27 January 2022 / Published: 28 January 2022
(This article belongs to the Special Issue Colorectal Surgery: Current Challenges and Future Perspectives)
Surgical treatment of hemorrhoidal disease (HD) in inflammatory bowel disease (IBD) has been considered to be potentially harmful, but the evidence for this is poor. Therefore, a systematic review of the literature was undertaken to reappraise the safety and effectiveness of surgical treatments in this special circumstance. A MEDLINE, Web of Science, Scopus, and Cochrane Library search was performed to retrieve studies reporting the outcomes of surgical treatment of HD in patients with Crohn’s disease (CD) and ulcerative colitis (UC). From a total of 2072 citations, 10 retrospective studies including 222 (range, 2–70) patients were identified. Of these, 119 (54%) had CD and 103 (46%) UC. Mean age was between 41 and 49 years (range 14–77). Most studies lacked information on the interval between surgery and the onset of complications. Operative treatments included open or closed hemorrhoidectomy (n = 156 patients (70%)), rubber band ligation (n = 39 (18%)), excision or incision of thrombosed hemorrhoid (n = 14 (6%)), and doppler-guided hemorrhoidal artery ligation (DG-HAL, n = 13 (6%)). In total, 23 patients developed a complication (pooled prevalence, 9%; (95%CI, 3–16%)), with a more than two-fold higher rate in patients with CD compared to UC (11% (5–16%) vs. 5% (0–13%), respectively). Despite the low quality evidence, surgical management of HD in IBD and particularly in CD patients who have failed nonoperative therapy should still be performed with caution and limited to inactive disease. Further studies should determine whether advantages in terms of safety and effectiveness with the use of non-excisional techniques (e.g., DG-HAL) can be obtained in this patient population. View Full-Text
Keywords: hemorrhoidal disease; IBD; Crohn; ulcerative colitis; hemorrhoidectomy; surgery hemorrhoidal disease; IBD; Crohn; ulcerative colitis; hemorrhoidectomy; surgery
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MDPI and ACS Style

Grossi, U.; Gallo, G.; Di Tanna, G.L.; Bracale, U.; Ballo, M.; Galasso, E.; Kazemi Nava, A.; Zucchella, M.; Cinetto, F.; Rattazzi, M.; Felice, C.; Zanus, G. Surgical Management of Hemorrhoidal Disease in Inflammatory Bowel Disease: A Systematic Review with Proportional Meta-Analysis. J. Clin. Med. 2022, 11, 709. https://doi.org/10.3390/jcm11030709

AMA Style

Grossi U, Gallo G, Di Tanna GL, Bracale U, Ballo M, Galasso E, Kazemi Nava A, Zucchella M, Cinetto F, Rattazzi M, Felice C, Zanus G. Surgical Management of Hemorrhoidal Disease in Inflammatory Bowel Disease: A Systematic Review with Proportional Meta-Analysis. Journal of Clinical Medicine. 2022; 11(3):709. https://doi.org/10.3390/jcm11030709

Chicago/Turabian Style

Grossi, Ugo, Gaetano Gallo, Gian Luca Di Tanna, Umberto Bracale, Mattia Ballo, Elisa Galasso, Andrea Kazemi Nava, Martino Zucchella, Francesco Cinetto, Marcello Rattazzi, Carla Felice, and Giacomo Zanus. 2022. "Surgical Management of Hemorrhoidal Disease in Inflammatory Bowel Disease: A Systematic Review with Proportional Meta-Analysis" Journal of Clinical Medicine 11, no. 3: 709. https://doi.org/10.3390/jcm11030709

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