Is hemorrhoidal surgery really unsafe in inflammatory bowel disease? Results from the HEAD-IBD multicenter study on behalf of IG-IBD.
15 affiliations
- 1Department of Medicine (DIMED), University of Padova, Padua, Italy. [email protected].
- 2Medicine 1, Ca' Foncello University Hospital, Treviso, Italy. [email protected].
- 3Department of Translational Medicine and Surgery, Hospital Isola Tiberina Gemelli Isola, Catholic University of Rome, Rome, Italy.
- 4Colorectal Surgery Unit, Faculty of Medicine and Surgery, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.
- 5University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland.
- 6Gastroenterology Unit, Ca' Foncello University Hospital, Treviso, Italy.
- 7Department of Surgical Sciences, University of Rome Tor Vergata, Rome, Italy.
- 8Medicine 1, Ca' Foncello University Hospital, Treviso, Italy.
- 9Medicina Interna e Gastroenterologia, UOS Malattie Infiammatorie Croniche Intestinali, IBD Unit, CEMAD - Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy.
- 10Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy.
- 11L. Sacco University Hospital General Surgery II, Milan, Italy.
- 12Department of Gastroenterology, IBD Unit, San Filippo Neri Hospital, ASL ROMA 1, Rome, Italy.
- 13UOC Chirurgia Generale, AUSL Modena, Modena, Italy.
- 14Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy.
- 15Proctology and Pelviperineology Unit, Humanitas Gavazzeni and Castelli, Bergamo, Italy.
Abstract
Background
Surgical management of hemorrhoidal disease (HD) in patients with IBD remains controversial because of concerns about impaired outcomes. This study aimed to evaluate the safety and IBD-related outcomes of surgical treatments for HD in patients with IBD and to explore factors potentially associated with postoperative complications and IBD flare.Methods
HEAD-IBD is a retrospective cohort study promoted by the Italian Group for the study of IBD (IG-IBD). Adults with established ulcerative colitis (UC) or Crohn's disease (CD) who underwent surgery for HD between 2004 and 2024 and had at least 12 months of follow-up were included. Surgical techniques, 1-, 6-, and 12-month complications, IBD flares (6 months), new onset perianal disease, and continence outcomes were analyzed.Results
A total of 38 patients were included (21 UC, 17 CD), 55% male. Clinically active disease at the last gastroenterology visit prior to surgery was present in 24% of UC and 41% of patients with CD. Open excisional hemorrhoidectomy was the most frequently performed procedure in both groups (66% UC, 73% CD), while non-excisional techniques were used in approximately one-third of cases. No 30-day or 6-month surgical complications occurred in patients with CD. Postoperative surgical complications were observed exclusively in patients with UC (5/21, 24%) and were mostly mild. Within 6 months after surgery, IBD flares occurred in 6 patients (16%), proportionally comparable between CD and UC. During overall follow-up, new-onset perianal disease developed in 5 patients (13%), predominantly in CD (4/5 cases), while new-onset incontinence was observed in 2 (5%) patients, both managed conservatively.Conclusions
In this largest European multicenter cohort, surgical treatment of HD in IBD was associated with low morbidity and preservation of anorectal function. These findings support a more individualized approach and underscore the need for prospective studies.
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BibTeX
@article{felice2026hemorrhoidal,
title = {{Is hemorrhoidal surgery really unsafe in inflammatory bowel disease? Results from the HEAD-IBD multicenter study on behalf of IG-IBD.}},
author = {C Felice and D Pugliese and G Gallo and G L Di Tanna and M Ascolani and G S Sica and V Bellato and M Franco and F Scaldaferri and L Parisio and F Colombo and A Bondurri and C Guerci and A Aratari and S Festa and F Ascari and E V Savarino and U Grossi},
journal = {Techniques in coloproctology},
year = {2026},
month = jul,
doi = {10.1007/s10151-026-03394-6},
url = {https://europepmc.org/article/MED/42907681},
note = {CC BY},
}
RIS
TY - JOUR
TI - Is hemorrhoidal surgery really unsafe in inflammatory bowel disease? Results from the HEAD-IBD multicenter study on behalf of IG-IBD.
AU - C Felice
AU - D Pugliese
AU - G Gallo
AU - G L Di Tanna
AU - M Ascolani
AU - G S Sica
AU - V Bellato
AU - M Franco
AU - F Scaldaferri
AU - L Parisio
AU - F Colombo
AU - A Bondurri
AU - C Guerci
AU - A Aratari
AU - S Festa
AU - F Ascari
AU - E V Savarino
AU - U Grossi
PY - 2026
DA - 2026/07/26
JO - Techniques in coloproctology
DO - 10.1007/s10151-026-03394-6
UR - https://europepmc.org/article/MED/42907681
AB - Background Surgical management of hemorrhoidal disease (HD) in patients with IBD remains controversial because of concerns about impaired outcomes. This study aimed to evaluate the safety and IBD-related outcomes of surgical treatments for HD in patients with IBD and to explore factors potentially associated with postoperative complications and IBD flare.Methods HEAD-IBD is a retrospective cohort study promoted by the Italian Group for the study of IBD (IG-IBD). Adults with established ulcerative colitis (UC) or Crohn's disease (CD) who underwent surgery for HD between 2004 and 2024 and had at least 12 months of follow-up were included. Surgical techniques, 1-, 6-, and 12-month complications, IBD flares (6 months), new onset perianal disease, and continence outcomes were analyzed.Results A total of 38 patients were included (21 UC, 17 CD), 55% male. Clinically active disease at the last gastroenterology visit prior to surgery was present in 24% of UC and 41% of patients with CD. Open excisional hemorrhoidectomy was the most frequently performed procedure in both groups (66% UC, 73% CD), while non-excisional techniques were used in approximately one-third of cases. No 30-day or 6-month surgical complications occurred in patients with CD. Postoperative surgical complications were observed exclusively in patients with UC (5/21, 24%) and were mostly mild. Within 6 months after surgery, IBD flares occurred in 6 patients (16%), proportionally comparable between CD and UC. During overall follow-up, new-onset perianal disease developed in 5 patients (13%), predominantly in CD (4/5 cases), while new-onset incontinence was observed in 2 (5%) patients, both managed conservatively.Conclusions In this largest European multicenter cohort, surgical treatment of HD in IBD was associated with low morbidity and preservation of anorectal function. These findings support a more individualized approach and underscore the need for prospective studies.
SN - 1123-6337
SN - 1128-045X
ER -