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Background <p>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.</p> Methods <p>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&#xa0;months of follow-up were included. Surgical techniques, 1-, 6-, and 12-month complications, IBD flares (6&#xa0;months), new onset perianal disease, and continence outcomes were analyzed.</p> Results <p>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&#xa0;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.</p> Conclusions <p>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.</p>

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Is hemorrhoidal surgery really unsafe in inflammatory bowel disease? Results from the HEAD-IBD multicenter study on behalf of IG-IBD

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月26日

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  • C. Felice,
  • D. Pugliese,
  • G. Gallo,
  • G. L. Di Tanna,
  • M. Ascolani,
  • G. S. Sica,
  • V. Bellato,
  • M. Franco,
  • F. Scaldaferri,
  • L. Parisio,
  • F. Colombo,
  • A. Bondurri,
  • C. Guerci,
  • A. Aratari,
  • S. Festa,
  • F. Ascari,
  • E. V. Savarino,
  • U. Grossi

摘要

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.