Annals of Coloproctology (Aug 2024)

The Italian Unitary Society of Colon-Proctology (Società Italiana Unitaria di Colonproctologia) guidelines for the management of acute and chronic hemorrhoidal disease

  • Antonio Brillantino,
  • Adolfo Renzi,
  • Pasquale Talento,
  • Luigi Brusciano,
  • Luigi Marano,
  • Maurizio Grillo,
  • Mauro Natale Maglio,
  • Fabrizio Foroni,
  • Alessio Palumbo,
  • Maria Laura Sandoval Sotelo,
  • Luciano Vicenzo,
  • Michele Lanza,
  • Giovanna Frezza,
  • Massimo Antropoli,
  • Claudio Gambardella,
  • Luigi Monaco,
  • Ilaria Ferrante,
  • Domenico Izzo,
  • Alfredo Giordano,
  • Michele Pinto,
  • Corrado Fantini,
  • Marcello Gasparrini,
  • Michele Schiano Di Visconte,
  • Francesca Milazzo,
  • Giovanni Ferreri,
  • Andrea Braini,
  • Umberto Cocozza,
  • Massimo Pezzatini,
  • Valeria Gianfreda,
  • Alberto Di Leo,
  • Vincenzo Landolfi,
  • Umberto Favetta,
  • Sergio Agradi,
  • Giovanni Marino,
  • Massimiliano Varriale,
  • Massimo Mongardini,
  • Claudio Eduardo Fernando Antonio Pagano,
  • Riccardo Brachet Contul,
  • Nando Gallese,
  • Giampiero Ucchino,
  • Michele D’Ambra,
  • Roberto Rizzato,
  • Giacomo Sarzo,
  • Bruno Masci,
  • Francesca Da Pozzo,
  • Simona Ascanelli,
  • Patrizia Liguori,
  • Angela Pezzolla,
  • Francesca Iacobellis,
  • Erika Boriani,
  • Eugenio Cudazzo,
  • Francesca Babic,
  • Carmelo Geremia,
  • Alessandro Bussotti,
  • Mario Cicconi,
  • Antonia Di Sarno,
  • Federico Maria Mongardini,
  • Antonio Brescia,
  • Leonardo Lenisa,
  • Massimiliano Mistrangelo,
  • Matteo Zuin,
  • Marta Mozzon,
  • Alessandro Paolo Chiriatti,
  • Vincenzo Bottino,
  • Antonio Ferronetti,
  • Corrado Rispoli,
  • Ludovico Carbone,
  • Giuseppe Calabrò,
  • Antonino Tirrò,
  • Domenico de Vito,
  • Giovanna Ioia,
  • Giovanni Luca Lamanna,
  • Lorenzo Asciore,
  • Ettore Greco,
  • Pierluigi Bianchi,
  • Giuseppe D’Oriano,
  • Alessandro Stazi,
  • Nicola Antonacci,
  • Raffaella Marina Di Renzo,
  • Gianmario Edoardo Poto,
  • Giuseppe Paolo Ferulano,
  • Antonio Longo,
  • Ludovico Docimo

DOI
https://doi.org/10.3393/ac.2023.00871.0124
Journal volume & issue
Vol. 40, no. 4
pp. 287 – 320

Abstract

Read online

The aim of these evidence-based guidelines is to present a consensus position from members of the Italian Unitary Society of Colon-Proctology (Società Italiana Unitaria di Colon-Proctologia, SIUCP) on the diagnosis and management of hemorrhoidal disease, with the goal of guiding physicians in the choice of the best treatment option. A panel of experts was charged by the Board of the SIUCP to develop key questions on the main topics related to the management of hemorrhoidal disease and to perform an accurate and comprehensive literature search on each topic, in order to provide evidence-based answers to the questions and to summarize them in statements. All the clinical questions were discussed by the expert panel in multiple rounds through the Delphi approach and, for each statement, a consensus among the experts was reached. The questions were created according to PICO (patients, intervention, comparison, and outcomes) criteria, and the statements were developed adopting the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) methodology. In cases of grade 1 hemorrhoidal prolapse, outpatient procedures including hemorrhoidal laser procedure and sclerotherapy may be considered the preferred surgical options. For grade 2 prolapse, nonexcisional procedures including outpatient treatments, hemorrhoidal artery ligation and mucopexy, laser hemorrhoidoplasty, the Rafaelo procedure, and stapled hemorrhoidopexy may represent the first-line treatment options, whereas excisional surgery may be considered in selected cases. In cases of grades 3 and 4, stapled hemorrhoidopexy and hemorrhoidectomy may represent the most effective procedures, even if, in the expert panel opinion, stapled hemorrhoidopexy represents the gold-standard treatment for grade 3 hemorrhoidal prolapse.

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