Annals of Coloproctology

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Anorectal benign disease

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 Naycı, Aziz Arı, Ensar Çakır, Rozan Kaya, İlknur Turan, Taygun Gülşen, Serhat Meriç, Erkan Yavuz, Nihat Buğdaycı, Farid Mohamad Hamad, Sezai Leventoğlu, Ramazan Kozan, Özkan Akpınar, Hakan Yanar, Fatih Yanar, Hasan Fehmi Küçük, Mehmet Karahan, Selçuk Kaya, Nail Can Adıgüzel, Tolga Önder, İlker Abcı, Ahmet Zeki Aydın, Ömer Faruk Özkan, Nurhilal Kızıltoprak, Berkay Özcan, Anıl Orhan, Alp Ömer Cantürk, Murat Tan, Yusuf Bilgin, Harun Çok, Azamet Cezit, Mehmet Mahir Fersahoğlu, Mustafa Öncel; Ann Coloproctol. 2025;41(6):573-585. Published online December 30, 2025; DOI: https://doi.org/10.3393/ac.2025.00710.0101

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Abstract PDF Supplementary Material: 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

Influence of colonic mesenteric area on the number of lymph node retrieval for colon cancer: a prospective cohort study: Nadir Adnan Hacım, Ahmet Akbaş, Yigit Ulgen, Talar Vartanoglu Aktokmakyan, Serhat Meric, Merve Tokocin, Onder Karabay, Yuksel Altinel; Ann Coloproctol. 2023;39(1):77-84. Published online September 16, 2021; DOI: https://doi.org/10.3393/ac.2021.00444.0063

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Purpose
The minimum harvested 12 lymph nodes (LNs) is regarded as the limit for accurate staging of nodal status in colorectal cancer patients. Besides the association of the lengths of resected intestinal segments and vascular pedicles, the mesocolic mesenteric area’s impact on LN count has not been studied. We aimed to evaluate the associations between metric variables, including the mesocolic mesentery area on the nodal harvest.
Methods
All consecutive patients who underwent elective colectomy with a curative intention for colon adenocarcinoma were prospectively included. The metric variables included the lengths of resected intestinal segments, vascular pedicle, and colonic mesenteric area. The variables influencing the LN count and the correlation between the total LN count and the specimens’ relevant metric measurements were analyzed.
Results
There were 46 patients with a median age of 64 years. The median count for total LNs was 22, and the LN positivity was 59.2%. There was an inadequate LN yield (<12) in 3 patients (6.1%). No significant associations were found between the adequacy of nodal harvest and the demographic, clinical, and tumoral features (P>0.05). There were significant positive correlations between total LN number and length of vascular pedicle and mesenteric area (r=0.576, P<0.001 and r=0.566, P<0.001).
Conclusion
The length of the vascular pedicle and mesenteric area were significantly correlated with total LN counts. Although there was no significant impact on the length of resected segments, the colonic mesenteric area can be used alone as a measure for the assessment of the nodal yield in colon cancer.

Citations

Citations to this article as recorded by

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Annals of Coloproctology.2021; 37(6): 434. CrossRef

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