Efficacy and safety of low-dose triamcinolone acetonide injections in reducing stricture at stapled hemorrhoidopexy sites

Sangmin Youn; Dowon Kim; Jieun Kim; Jung-A Yun; Hyunjung Park

doi:10.3393/ac.2025.01088.0155

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Original Article Anorectal benign disease Efficacy and safety of low-dose triamcinolone acetonide injections in reducing stricture at stapled hemorrhoidopexy sites: Sangmin Youn¹, Dowon Kim², Jieun Kim¹, Jung-A Yun¹, Hyunjung Park¹; Annals of Coloproctology 2026;42(2):247-255.
DOI: https://doi.org/10.3393/ac.2025.01088.0155
Published online: April 15, 2026

¹Department of Surgery, Centum Surgical Clinic, Anyang, Korea

²Department of Gastroenterology, Centum Surgical Clinic, Anyang, Korea

Correspondence to: Sangmin Youn, MD, MS Department of Surgery, Centum Surgical Clinic, 142 Anyang-ro, Manan-gu, Anyang 14034, Korea Email: sangmin.youn@gmail.com

• Received: September 9, 2025 • Revised: November 13, 2025 • Accepted: November 17, 2025

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Abstract
Graphical abstract
INTRODUCTION
METHODS
RESULTS
DISCUSSION
ARTICLE INFORMATION
SUPPLEMENTARY MATERIALS
REFERENCES

Abstract

Purpose
Stapled hemorrhoidopexy (SH) is commonly used to treat severe internal hemorrhoids and rectal mucosal prolapse associated with prolapsing hemorrhoids. A common complication of SH is SH site stricture (SHsS), which negatively affects quality of life. This study evaluated the efficacy and safety of low-dose triamcinolone acetonide (TA) injection at the SH site for the prevention of SHsS.
Methods
Between 2020 and 2023, 1,023 patients underwent SH, with an average of 3.3 external hemorrhoids being excised per patient. The fluid mixture contained 40 mg of TA per 100 mL (0.4 mg/mL), with 5 mL (2 mg of TA) injected at the SH site and 2–3 mL (1.2 mg of TA) at each excisional hemorrhoidectomy site. The TA group (n=554; propensity score matching [PSM]-adjusted, n=375) received TA injections, whereas the non-TA group (n=469; after PSM, n=375) received conventional epinephrine injections. PSM was adjusted for age, sex, concurrent surgeries, botulinum toxin injection, and excisional hemorrhoidectomy frequency. Logistic regression models were used to analyze SHsS and reoperation rates.
Results
SHsS rate was significantly lower in the TA group (2.9%) than in the non-TA group (16.0%). Furthermore, the reoperation rate was lower in the TA group (5.9%) than in the non-TA group (14.4%).
Conclusion
Low-dose TA injections effectively prevent SHsS and reduce reoperation rates without increasing the risk of infection, providing a safe, cost-effective approach to improving surgical outcomes.
Keywords: Hemorrhoids; Stapled hemorrhoidopexy; Postoperative complications; Stricture; Triamcinolone acetonide

Graphical abstract

INTRODUCTION

Stapled hemorrhoidopexy (SH), introduced by Longo in 1993, is a surgical technique for treating severe grade 3–4 internal hemorrhoids and rectal mucosal prolapse [1, 2]. Compared with traditional hemorrhoidectomy, this method offers benefits such as reduced postoperative pain, minimal bleeding, and faster recovery [3].

SH site stricture (SHsS) is a common complication associated with SH, with an estimated prevalence of 2.5% to 10%. Some studies have reported that up to 22% of patients undergoing SH experience SHsS [4]. This complication is a significant concern because it can cause defecation difficulties and affect the long-term quality of life [5]. The need for additional surgical interventions and the potential impairment of anal function highlights the importance of addressing this issue. Various strategies have been developed to retain the benefits of SH while minimizing SHsS risk. These strategies include refining surgical techniques, such as modifying the purse-string suture to reduce sphincter muscle involvement and altering the anastomosis from a closed to an open loop using protective pads [5].

Furthermore, tissue-selecting therapy (TST), which involves partial rectal mucosa resection to decrease stricture formation, has been introduced and is currently in use [6]. Despite these efforts, existing surgical techniques and treatments remain insufficient in reducing stricture rates. Therefore, further advancements are necessary to maintain the advantages of SH while preventing SHsS risk. Triamcinolone acetonide (TA) is a corticosteroid commonly used to reduce wound inflammation and inhibit scar formation, thereby preventing scar retraction and stricture [7]. Although its use is avoided in high-risk infection areas owing to its immunosuppressive effects, it is used when benefits of inflammation control outweigh infection concerns [8–10].

The application of this approach in minimizing the occurrence of strictures has also been explored in gastrointestinal surgery. For example, TA can prevent esophageal strictures following endoscopic submucosal dissection of esophageal lesions. This approach has been shown to reduce strictures without increasing the risk of infection or complications [11], suggesting that TA is beneficial for safe prevention of SHsS.

Although the anus is prone to contamination, its dual blood supply and rich vascularization help reduce infection risks. Considering the need for preventing strictures after SH, this study introduced a low-dose TA (LTA) solution for SH. This study evaluated the efficacy of LTA in reducing SHsS and assessed the risk of reoperation and complications.

METHODS

Ethics statement

This retrospective study was reviewed and approved for exemption from ethical oversight by the public institutional review board operated by the National Bioethics Policy Institute (KONIBP), designated by the Korean Ministry of Health and Welfare (No. P01-202507-01-049). The exemption was granted because the study posed minimal risk, used deidentified retrospective data, and did not involve any intervention or identifiable personal information.

Study design and patients

The study included 1,023 adult patients diagnosed with grade 3 or 4 hemorrhoids who underwent SH between January 2020 and September 2023. Patients were categorized into 2 groups: the TA group (n=554), which received LTA solution, and non-TA group (n=469), which was treated with a conventional epinephrine solution (same epinephrine concentration in a normal saline base) using injection volumes identical to those in the TA group. The non-TA group did not receive any additional steroid treatments. All procedures were standardized and performed by experienced surgeons. Surgery was performed under caudal or spinal anesthesia in the jackknife position. Data, including demographic characteristics, surgical details, and postoperative outcomes, were collected retrospectively from electronic medical records. Patients with active infections or contraindications to corticosteroid use were excluded.

LTA preparation and injection

LTAs were prepared using 100 mL of normal saline as the base and combined with multiple agents to achieve the desired formulation. Each 100 mL of LTAs contained the following components: epinephrine (1 ampule, 1 mL, 1 mg), TA (40 mg, 1 ampule; Dongkwang), 2% lidocaine (5 mL), and sodium bicarbonate (2 mL, 2 mEq, 84 mg/mL; GCB Bone Injection, Greencross WB). The final TA concentration was 0.4 mg/mL. In this study, a lower TA concentration than that used in other studies was selected to balance safety and efficacy (Table 1) [11, 12]. For each patient, 20 mL of the prepared LTAs was used during surgery: 5 mL was injected at the SH site (Supplementary Fig. 1), and 2 to 3 mL was administered at each external hemorrhoidectomy site (Supplementary Fig. 2). All procedures followed a standardized preparation and injection protocol.

Surgical procedure

SH was performed using the REACH PPH-33D Procedure Set (Reach Surgical). A purse-string suture was placed using 2-0 polypropylene, encompassing the markings on the hemorrhoid apex and prolapsed rectal mucosa apex. The sutures were positioned approximately 1 to 2 cm above the dentate line to ensure inclusion of the mucosa and submucosa while avoiding the muscular layer. This procedure was followed by tissue excision and anastomosis using a circular stapler. Before stapler activation, 5 mL of LTAs or conventional epinephrine solution (5 mL) was injected into the SH site, and the area was massaged to ensure adequate infiltration. External hemorrhoids were excised using laser-designed submucosal hemorrhoidectomy. For patients with an anal resting pressure of ≥60 mmHg, determined by preoperative anal manometry, or those with high anal tone detected during digital rectal examination, botulinum toxin (20 units) was administered.

Postoperative assessment

SHsS was assessed through digital rectal examination at 2 and 4 weeks postoperatively. Because objective quantification of anastomotic narrowing at the stapled site is technically challenging, given that it lies deep within a narrow and contracted anal canal, evaluation relied on standardized tactile assessment by experienced colorectal surgeons, similar to how obstetricians estimate cervical dilation using finger width rather than precise numerical measurement. All surgeons adhered to predefined criteria and underwent internal training to ensure consistency in identifying SH-site narrowing and performing digital dilatation. SHsS was defined as the presence of resistance at or beyond the level of the proximal interphalangeal joint during digital rectal exam, requiring dilatation at the time of assessment. Although an objective numerical measurement of narrowing was not available, uniform clinical criteria were applied to reduce interexaminer variability.

To assess the safety of LTAs, reoperation due to postoperative complications was evaluated. The need for reoperation was particularly analyzed for skin tags, postoperative bleeding, and infectious complications, such as wound infection and fistula formation. Furthermore, the need for reoperation for strictures, including those affecting the anal canal or SH site and SH site granulation, was examined.

Statistical analysis

Baseline statistics are presented as mean±standard deviation for continuous variables and numbers (percentages) for categorical variables. Continuous variables were analyzed using the t-test, whereas categorical variables were assessed using either the chi-square test or Fisher exact test, as appropriate. To reduce potential confounding effects associated with factors such as age, sex, concurrent surgeries, botulinum toxin injection, and number of external hemorrhoids resected, 1:1 propensity score matching (PSM) was performed using the nearest neighbor method [13] with a caliper of 0.1 [14].

Logistic regression analysis was performed to adjust for covariates, including age, sex, concurrent surgeries, botulinum toxin injection, and number of external hemorrhoids resected. Incidence of SHsS and reoperation rates were compared between the 2 groups. Statistical analyses were performed using R ver. 4.4.1 (R Foundation for Statistical Computing), with the MatchIt package applied for PSM [15]. P-values of <0.05 were used to denote statistical significance.

RESULTS

Baseline patient characteristics

Baseline characteristics, including age, sex, concurrent surgeries, hospitalization duration, botulinum toxin injection use, and number of external hemorrhoids resected, were balanced using PSM (Table 2). After matching, the TA and non-TA groups comprised 375 patients each.

Main outcomes

Based on the PSM results, the incidence of SHsS was significantly lower in the TA group than in the non-TA group (2.9% vs. 16.0%, P<0.001) (Table 3, Fig. 1). The rate of reoperation due to complications was significantly lower in the TA group than in the non-TA group (5.9% vs. 14.4%, P<0.001) (Table 3, Fig. 2).

Specific causes for reoperation were compared between the 2 groups. The rate of reoperation due to infections was significantly lower in the TA group than in the non-TA group (2.7% vs. 6.7%, P=0.015). Delayed and immediate postoperative bleeding were less frequent in the TA group (0.8% and 0.5%, respectively) than in the non-TA group (1.3% and 1.6%, respectively), although these differences were not statistically significant (P=0.725 and P=0.286, respectively). The rate of reoperation due to skin tags was lower in the TA group than in the non-TA group (1.9% vs. 3.7%); however, this difference was not statistically significant (P=0.184).

Logistic regression analyses

SHsS predictors

Logistic regression analysis revealed that TA significantly reduced the risk of SHsS (Table 4). The crude odds ratio (OR) for TA use was 0.16 (95% confidence interval [CI], 0.08–0.31), indicating an 84% reduction in the risk of strictures compared with that in non-TA use (P<0.001). Adjusted OR (aOR) was 0.15 (95% CI, 0.08–0.30), confirming a statistically significant protective effect (P<0.001). Sex was also a significant factor, with women having a lower risk of stricture than men. The aOR was 0.26 (95% CI, 0.14–0.51), which was statistically significant (P<0.001). Other factors were not significantly associated with SHsS risk.

Predictors of reoperation due to complications

Logistic regression analysis revealed that TA significantly reduced the risk of reoperation due to postoperative complications (Table 5). The unadjusted OR (crude OR) was 0.37 (95% CI, 0.22–0.62), indicating a 63% lower risk of complications in the TA group than in the non-TA group (P<0.001). The aOR was 0.36 (95% CI, 0.21–0.6), which was also statistically significant (P<0.001). Although the number of external hemorrhoids resected was significantly associated with an increased risk of reoperation in the unadjusted analysis (crude OR, 1.32; P=0.017), this association was no longer significant after adjustment (aOR, 1.17; P=0.199). Other factors were not significantly associated with the risk of reoperation.

Predictors of specific complications leading to reoperation

Sex was significantly associated with reoperation due to skin tag formation, with women having a higher risk than men. The aOR was 13.23 (95% CI, 2.92–59.92; P<0.001) (Supplementary Table 1). Although TA appeared to reduce reoperation due to skin tag formation, this was not statistically significant. TA significantly decreased the risk of reoperation due to infectious complications (Supplementary Table 2). The crude OR and aOR were 0.38 (95% CI, 0.18–0.81; P=0.012) and 0.37 (95% CI, 0.17–0.78; P=0.009), respectively. Other factors were not significantly associated with infectious complications. Moreover, neither delayed nor immediate postoperative bleeding exhibited significant associations with the variables analyzed.

DISCUSSION

SH and SHsS

SH is effective for treating severe internal hemorrhoids and rectal mucosal prolapse associated with prolapsing hemorrhoids but is not indicated for full-thickness rectal prolapse. As of 2023, SH accounted for 27.9% of all hemorrhoid surgeries performed in Korea [16]. Consistent with previous reports demonstrating the benefits of SH, our clinical experience since 2017 has also confirmed that SH yields excellent outcomes in patients with severe internal hemorrhoids and rectal mucosal prolapse. By reducing blood flow from the rectum, it also minimizes bleeding during concomitant hemorrhoidectomy, facilitating easier excision of external hemorrhoids. However, SHsS remains a significant challenge associated with SH. At our institution, 16% of patients who did not receive LTAs developed SHsS, with subclinical cases potentially increasing this rate. Au-Yong et al. [4] reported that SHsS occurs in 2.5% to 10% of cases, with some studies showing rates as high as 22%. Unlike acute complications, such as bleeding and infection, SHsS is a lifelong problem that can result in defecation difficulties and a persistent sensation of incomplete evacuation, which significantly affects quality of life.

Although methods such as refined suturing techniques and TST have been explored, they struggle to effectively manage severe internal hemorrhoids and circular prolapsing rectal mucosal prolapse, limiting their role as comprehensive solutions. Labor-intensive approaches, such as the removal of the circumferential staples of the anastomosis and replacing them with a hand-sewn anastomosis, have been used to reduce stricture. Liu et al. [17] reported that this approach resulted in severe clinical stricture in 2.7% of the modified SH group, compared with 6.7% in the standard SH group. However, such labor-intensive procedures remain necessary, and the rate of severe stricture remains significant, highlighting the need for a simpler, more efficient, and effective method to reduce SHsS.

TA as a preventive measure for SHsS

To reduce the risk of SHsS, various strategies have been explored, including the use of oral steroids or TA injections. Hashimoto et al. [11] reported that 2 sessions of TA injections after widespread endoscopic submucosal dissection significantly reduced the incidence of esophageal stricture and the need for endoscopic balloon dilations. The stricture rate was significantly lower in the TA group than in the control group (45.7% vs. 73.9%, P=0.031), and the median number of required endoscopic balloon dilations was also lower (0 vs. 4, P<0.001). The study concluded that 2 sessions of TA injection were an effective and safe approach for preventing esophageal strictures after endoscopic submucosal dissection.

Similarly, local steroids, particularly TA and methylprednisolone, have been widely studied for their ability to reduce recurrence and delay time-to-recurrence in urethral strictures when combined with internal urethrotomy (IU). For example, Soliman et al. [18] conducted a meta-analysis and reported that adjunctive steroid use with IU reduces recurrence rates and time-to-recurrence, highlighting its importance in improving the quality of life of patients with urethral strictures.

A review of the existing literature provides useful insights into determining the optimal concentration and total dosage of TA. Hashimoto et al. [11] used 5-mg/mL TA in the first session (0.5 mL per point at 10-mm intervals, totaling 40–100 mg depending on the ulcer base) and 10-mg/mL TA in the second session (0.2 mL per point, totaling 16–50 mg). Yıldırım et al. [19] reported the safety and effectiveness of intralesional injections of methylprednisolone (40 mg per 1 cm of stricture length) during IU, which reduced recurrence rates. Similarly, Hebert [20] used transurethral TA injections (up to 200 mg), and Mazdak et al. [21] reported that 40 mg of TA injected submucosally at the urethrotomy site significantly reduced recurrence rates. These studies have emphasized the potential of steroid injection to reduce recurrence and delay progression, with doses varying from 40 to 200 mg, depending on the application.

The use of TA has been investigated in various surgical and medical settings. For example, Neil-Dwyer et al. [12] applied preoperative tumescent steroid infiltration (0.1 mg/mL of TA) to reduce postoperative swelling in patients undergoing craniomaxillofacial surgery. Intra-articular injections of TA for arthritis range from 2.5 to 5 mg for smaller joints and up to 40 mg for larger joints. In dermatology, doses varied according to condition, with 1 to 2 mg/mL for cystic acne, 2 to 5 mg/mL for hidradenitis suppurativa, and up to 40 mg/mL per session for keloid treatment. Based on these findings, LTAs was used to balance efficacy and safety while minimizing infection risks. The final solution contained 40 mg of TA in 100 mL of normal saline, yielding a concentration of 0.4 mg/mL. For the SH site, 5 mL (equivalent to 2 mg of TA) was injected submucosally near the resection area after tightening the purse-string suture but before stapler firing, followed by gentle massage to ensure uniform distribution of the solution (Supplementary Fig. 1). For each external hemorrhoid site, 3 mL (equivalent to 1.2 mg of TA) was administered via submucosal injection into the hemorrhoidal tissue with adequate infiltration, also followed by gentle massage to promote even diffusion (Supplementary Fig. 2). The total TA dosage per patient ranged from 5 to 8 mg, which is consistent with previous studies while ensuring patient safety.

Reduced incidence of SHsS with TA use

The incidence of postoperative SHsS was significantly lower in the TA group than in the non-TA group (2.9% vs. 16.0%, P<0.001). Even mild strictures, which were frequently observed in the non-TA group, were rarely noted following TA administration. Logistic regression analysis identified TA as an independent protective factor against SHsS, consistent with the findings from the PSM analysis.

This result introduces a novel concept of pharmacologic modulation of wound fibrosis in anorectal surgery. Unlike previous efforts that focused on mechanical or technical adjustments (e.g., TST, refined stapling, or hand-sewn anastomosis), LTA offers a biologic approach to suppress excessive inflammation and fibroblast proliferation at the anastomotic site. Clinically, this method provides a simple, reproducible adjunct to reduce postoperative stricture formation without modifying the surgical technique itself.

Furthermore, the observed sex-related difference, where women exhibited a lower risk of SHsS, may reflect baseline variations in anal sphincter tone and bowel habits. Nevertheless, the consistent protective effect of TA across both sexes emphasizes its therapeutic efficacy independent of patient physiology.

Reoperation rates and infectious complications

A primary concern regarding the use of TA is the potential for increased postoperative complications requiring reoperation. Steroids are contraindicated in infected wounds because they increase infection risk and delay healing. However, because anal wounds benefit from a dual blood supply and are classified as contaminated but not infected, TA was introduced at a low concentration. This approach was further supported by evidence from other studies indicating that TA does not increase the risk of infectious complications or hinder wound healing, even in conditions such as acne or at high-risk sites such as hidradenitis suppurativa and the gastrointestinal tract.

The overall reoperation rate was significantly lower in the TA group than in the non-TA group (5.9% vs. 14.4%, P<0.001). In particular, reoperations due to infectious wound complications decreased from 6.7% to 2.7% (P=0.015), with multivariate analysis identifying TA as a significant independent factor (aOR, 0.37; 95% CI, 0.17–0.78; P=0.009).

These findings suggest that the anti-inflammatory and antiedematous effects of TA contribute to optimizing the local wound environment. By reducing acute inflammation and tissue edema, TA likely enhances perfusion and drainage, thereby lowering infection risk and supporting smoother wound healing.

Importantly, this evidence indicates that controlled, low-dose corticosteroid administration can be both safe and advantageous in anorectal surgery, challenging the long-standing concern that steroids inherently impair wound healing. Clinically, the incorporation of LTA may reduce the need for secondary interventions and promote improved postoperative recovery without increasing complication rates.

LTA: a novel hemorrhoidectomy solution that efficiently and safely reduces stricture

TA is used cautiously because of concerns regarding infection risk and wound healing delays. However, our findings revealed that TA not only prevents SHsS but also reduces reoperation rates and infectious wound complications. Hence, TA is an effective and safe treatment option that requires neither modification of the surgical technique nor the use of expensive equipment, because it involves the application of a low-cost, readily available medication. In conclusion, LTAs is a novel, safe, and cost-effective approach to effectively reducing SHsS.

Clinical implications and future directions

The low-dose regimen applied in this study was selected after reviewing prior reports on perioperative steroid injection, taking into account that the anal region constitutes a contaminated but not “dirty” surgical field. Accordingly, a conservative low-dose strategy was adopted to minimize potential risks of infection or delayed wound healing. Despite this cautious approach, the findings demonstrated a distinct protective effect of TA, with significant reductions in SHsS, infectious complications, and reoperation rates. Given these favorable outcomes, higher or repeated dosing was not investigated in this study.

This study should therefore be considered a pilot investigation demonstrating that LTA can be used safely to reduce postoperative stricture without increasing infection risk. Future multicenter randomized controlled trials with varying concentrations or dosing schedules are warranted to clarify the optimal dose–response relationship and establish standardized treatment protocols.

Several limitations should be acknowledged. The retrospective design, single-institution setting, and absence of systematic long-term follow-up may restrict causal inference and generalizability, highlighting the need for future prospective multicenter studies to validate these findings. All patients underwent routine postoperative assessment only at 2 and 4 weeks, and were instructed to return if any symptoms or complications developed. Although all reoperated cases were included in the dataset, mild or delayed strictures—or late-onset functional issues that did not cause significant symptoms—may have been underdetected. Because direct measurement of SH-site narrowing is technically challenging due to the deep and narrow anal canal, evaluations were based on standardized tactile assessment by experienced colorectal surgeons. While this method is clinically practical, it may still involve some degree of subjectivity.

Regardless of these limitations, our findings demonstrate that LTA reduces postoperative stricture and reoperation rates following hemorrhoid surgery, particularly SH, without increasing the risk of infection. By suppressing inflammation and fibrosis, TA improves surgical outcomes while maintaining a favorable safety profile. These results challenge previous concerns regarding steroid use in anorectal wounds and suggest that LTA is a safe and cost-effective adjunct to both stapled and conventional hemorrhoidectomy. Further research is warranted to establish standardized protocols and evaluate long-term outcomes.

ARTICLE INFORMATION

Conflict of interest

No potential conflict of interest relevant to this article was reported.

Funding

None.

Author contributions

Conceptualization: SY; Data curation: SY, JK, HP; Formal analysis: SY, JAY; Investigation: SY, JK, HP; Methodology: SY, JAY; Project administration: SY; Resources: SY, JK, HP; Software: SY, DK; Validation: SY, JAY; Visualization: SY; Writing–original draft: SY; Writing–review & editing: all authors. All authors read and approved the final manuscript.

SUPPLEMENTARY MATERIALS

Supplementary Table 1.

Logistic regression analysis for predicting postoperative skin tag formation after surgery

ac-2025-01088-0155-Supplementary-Table-1.pdf

Supplementary Table 2.

Logistic regression analysis for predicting infectious wound complications after surgery

ac-2025-01088-0155-Supplementary-Table-2.pdf

Supplementary Fig. 1.

In total, 5 mL of low-dose triamcinolone acetonide was injected into the stapled hemorrhoidopexy site before stapler activation.

ac-2025-01088-0155-Supplementary-Fig-1.pdf

Supplementary Fig. 2.

For each hemorrhoid scheduled for resection, 2–3 mL of low-dose triamcinolone acetonide was administered.

ac-2025-01088-0155-Supplementary-Fig-2.pdf

Supplementary materials are available from https://doi.org/10.3393/ac.2025.01088.0155.

Fig. 1.

Incidence of stapled hemorrhoidopexy site stricture (SHsS) in patients with and without triamcinolone acetonide (TA) injection.

Fig. 2.

Reoperation rate due to complications in patients with and without triamcinolone acetonide (TA) injection.

Table 1.

Comparison of LTA solutions and their dosages in various clinical applications

Variable	TA dosage (mg/mL)
LTA	0.4
TA injection to prevent esophageal stricture after ESD [11]	First session: 5
TA injection to prevent esophageal stricture after ESD [11]	Second session: 10
TA infiltration to reduce postoperative swelling after craniofacial surgery [12]	0.1
Dermatological application
TA for cystic acne	1–2
TA for hidradenitis suppurativa	2–5
TA for keloid	Up to 40

LTA, low-dose triamcinolone acetonide; TA, triamcinolone acetonide; ESD, endoscopic submucosal dissection.

Table 2.

Baseline patient characteristics and PSM results for the TA and non-TA groups

Characteristic	Before PSM				After PSM
Characteristic	Non-TA group (n=469)	TA group (n=554)	SMD	P-value	Non-TA group (n=375)	TA group (n=375)	SMD	P-value
Female sex	176 (37.5)	293 (52.9)	0.312	<0.001	164 (43.7)	164 (43.7)	<0.001	>0.999
Age (yr)	49.95±13.10	47.32±13.70	0.196	0.002	49.00±13.19	47.81±14.36	0.086	0.239
Concurrent operation with SH	49 (10.4)	56 (10.1)	0.011	0.94	43 (11.5)	41 (10.9)	0.017	0.908
Length of hospital stay (day)	2.15±0.64	2.23±0.85	0.106	0.088	2.17±0.68	2.18±0.74	0.023	0.758
Botulinum toxin injection	206 (43.9)	370 (66.8)	0.473	<0.001	197 (52.5)	204 (54.4)	0.037	0.660
No. of excisional hemorrhoidectomies	3.36±1.23	3.14±1.06	0.199	0.002	3.28±1.23	3.26±1.02	0.014	0.847

Values are presented as number (%) or mean±standard deviation.

PSM, propensity score matching; TA, triamcinolone acetonide; SMD, standardized mean difference; SH, stapled hemorrhoidopexy.

Table 3.

Comparison of SHsS and reoperation for complications between the TA and non-TA groups after PSM (n=750)

Outcome	Non-TA group (n=375)	TA group (n=375)	SMD	P-value
Incidence of SHsS	60 (16.0)	11 (2.9)	0.458	<0.001
Reoperation due to complication	54 (14.4)	22 (5.9)	0.286	<0.001
SH site stenosis	1 (0.3)	0 (0)	0.073	>0.999
Anal canal stenosis	2 (0.5)	0 (0)	0.104	0.499
Infectious wound complication	25 (6.7)	10 (2.7)	0.191	0.015
Delayed bleeding	5 (1.3)	3 (0.8)	0.052	0.725
Skin tag	14 (3.7)	7 (1.9)	0.113	0.184
Immediate postoperative bleeding	6 (1.6)	2 (0.5)	0.104	0.286
Granuloma	1 (0.3)	0 (0)	0.073	>0.999

Values are presented as number (%).

SHsS, stapled hemorrhoidopexy site stricture; TA, triamcinolone acetonide; PSM, propensity score matching; SMD, standardized mean difference; SH, stapled hemorrhoidopexy.

Table 4.

Logistic regression analysis for predicting SHsS

Variable	Univariable analysis		Multivariable analysis
Variable	Crude OR (95% CI)	P-value	aOR (95% CI)	P-value
Female sex	0.29 (0.16–0.52)	<0.001	0.26 (0.14–0.51)	<0.001
Age (yr)	1.02 (1.00–1.03)	0.083	1.02 (1.00–1.04)	0.125
Concurrent operation with SH	1.17 (0.56–2.45)	0.679	0.94 (0.43–2.08)	0.886
Length of hospital stay (day)	0.89 (0.61–1.31)	0.561	0.91 (0.61–1.34)	0.631
TA use	0.16 (0.08–0.31)	<0.001	0.15 (0.08–0.30)	<0.001
Botulinum toxin injection	1.00 (0.61–1.64)	0.992	0.95 (0.52–1.73)	0.871
No. of excisional hemorrhoidectomies	0.86 (0.7–1.05)	0.143	0.99 (0.78–1.25)	0.901

SHsS, stapled hemorrhoidopexy site stricture; OR, odds ratio; CI, confidence interval; aOR, adjusted odds ratio; SH, stapled hemorrhoidopexy; TA, triamcinolone acetonide.

Table 5.

Logistic regression analysis for predicting reoperation due to postoperative complications

Variable	Univariable analysis		Multivariable analysis
Variable	Crude OR (95% CI)	P-value	aOR (95% CI)	P-value
Female sex	1.40 (0.87–2.26)	0.161	1.46 (0.87–2.46)	0.154
Age (yr)	0.99 (0.97–1.00)	0.109	0.99 (0.97–1.01)	0.230
Concurrent operation with SH	1.57 (0.81–3.04)	0.184	1.92 (0.96–3.83)	0.065
Length of hospital stay (day)	1.05 (0.76–1.45)	0.755	1.06 (0.75–1.49)	0.735
TA use	0.37 (0.22–0.62)	<0.001	0.36 (0.21–0.60)	<0.001
Botulinum toxin injection	1.56 (0.96–2.54)	0.076	1.50 (0.85–2.63)	0.162
No. of excisional hemorrhoidectomies	1.32 (1.05–1.66)	0.017	1.17 (0.92–1.50)	0.199

OR, odds ratio; CI, confidence interval; aOR, adjusted odds ratio; SH, stapled hemorrhoidopexy; TA, triamcinolone acetonide.

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Efficacy and safety of low-dose triamcinolone acetonide injections in reducing stricture at stapled hemorrhoidopexy sites

Ann Coloproctol. 2026;42(2):247-255. Published online April 15, 2026

DOI: https://doi.org/10.3393/ac.2025.01088.0155

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Figure

Efficacy and safety of low-dose triamcinolone acetonide injections in reducing stricture at stapled hemorrhoidopexy sites

Fig. 1. Incidence of stapled hemorrhoidopexy site stricture (SHsS) in patients with and without triamcinolone acetonide (TA) injection.

Fig. 2. Reoperation rate due to complications in patients with and without triamcinolone acetonide (TA) injection.

Graphical abstract

Fig. 1.

Fig. 2.

Graphical abstract

Efficacy and safety of low-dose triamcinolone acetonide injections in reducing stricture at stapled hemorrhoidopexy sites

Variable	TA dosage (mg/mL)
LTA	0.4
TA injection to prevent esophageal stricture after ESD [11]	First session: 5
TA injection to prevent esophageal stricture after ESD [11]	Second session: 10
TA infiltration to reduce postoperative swelling after craniofacial surgery [12]	0.1
Dermatological application
TA for cystic acne	1–2
TA for hidradenitis suppurativa	2–5
TA for keloid	Up to 40

Characteristic	Before PSM				After PSM
Characteristic	Non-TA group (n=469)	TA group (n=554)	SMD	P-value	Non-TA group (n=375)	TA group (n=375)	SMD	P-value
Female sex	176 (37.5)	293 (52.9)	0.312	<0.001	164 (43.7)	164 (43.7)	<0.001	>0.999
Age (yr)	49.95±13.10	47.32±13.70	0.196	0.002	49.00±13.19	47.81±14.36	0.086	0.239
Concurrent operation with SH	49 (10.4)	56 (10.1)	0.011	0.94	43 (11.5)	41 (10.9)	0.017	0.908
Length of hospital stay (day)	2.15±0.64	2.23±0.85	0.106	0.088	2.17±0.68	2.18±0.74	0.023	0.758
Botulinum toxin injection	206 (43.9)	370 (66.8)	0.473	<0.001	197 (52.5)	204 (54.4)	0.037	0.660
No. of excisional hemorrhoidectomies	3.36±1.23	3.14±1.06	0.199	0.002	3.28±1.23	3.26±1.02	0.014	0.847

Outcome	Non-TA group (n=375)	TA group (n=375)	SMD	P-value
Incidence of SHsS	60 (16.0)	11 (2.9)	0.458	<0.001
Reoperation due to complication	54 (14.4)	22 (5.9)	0.286	<0.001
SH site stenosis	1 (0.3)	0 (0)	0.073	>0.999
Anal canal stenosis	2 (0.5)	0 (0)	0.104	0.499
Infectious wound complication	25 (6.7)	10 (2.7)	0.191	0.015
Delayed bleeding	5 (1.3)	3 (0.8)	0.052	0.725
Skin tag	14 (3.7)	7 (1.9)	0.113	0.184
Immediate postoperative bleeding	6 (1.6)	2 (0.5)	0.104	0.286
Granuloma	1 (0.3)	0 (0)	0.073	>0.999

Variable	Univariable analysis		Multivariable analysis
Variable	Crude OR (95% CI)	P-value	aOR (95% CI)	P-value
Female sex	0.29 (0.16–0.52)	<0.001	0.26 (0.14–0.51)	<0.001
Age (yr)	1.02 (1.00–1.03)	0.083	1.02 (1.00–1.04)	0.125
Concurrent operation with SH	1.17 (0.56–2.45)	0.679	0.94 (0.43–2.08)	0.886
Length of hospital stay (day)	0.89 (0.61–1.31)	0.561	0.91 (0.61–1.34)	0.631
TA use	0.16 (0.08–0.31)	<0.001	0.15 (0.08–0.30)	<0.001
Botulinum toxin injection	1.00 (0.61–1.64)	0.992	0.95 (0.52–1.73)	0.871
No. of excisional hemorrhoidectomies	0.86 (0.7–1.05)	0.143	0.99 (0.78–1.25)	0.901

Variable	Univariable analysis		Multivariable analysis
Variable	Crude OR (95% CI)	P-value	aOR (95% CI)	P-value
Female sex	1.40 (0.87–2.26)	0.161	1.46 (0.87–2.46)	0.154
Age (yr)	0.99 (0.97–1.00)	0.109	0.99 (0.97–1.01)	0.230
Concurrent operation with SH	1.57 (0.81–3.04)	0.184	1.92 (0.96–3.83)	0.065
Length of hospital stay (day)	1.05 (0.76–1.45)	0.755	1.06 (0.75–1.49)	0.735
TA use	0.37 (0.22–0.62)	<0.001	0.36 (0.21–0.60)	<0.001
Botulinum toxin injection	1.56 (0.96–2.54)	0.076	1.50 (0.85–2.63)	0.162
No. of excisional hemorrhoidectomies	1.32 (1.05–1.66)	0.017	1.17 (0.92–1.50)	0.199

Table 1. Comparison of LTA solutions and their dosages in various clinical applications

LTA, low-dose triamcinolone acetonide; TA, triamcinolone acetonide; ESD, endoscopic submucosal dissection.

Table 2. Baseline patient characteristics and PSM results for the TA and non-TA groups

Values are presented as number (%) or mean±standard deviation.

PSM, propensity score matching; TA, triamcinolone acetonide; SMD, standardized mean difference; SH, stapled hemorrhoidopexy.

Table 3. Comparison of SHsS and reoperation for complications between the TA and non-TA groups after PSM (n=750)

Values are presented as number (%).

SHsS, stapled hemorrhoidopexy site stricture; TA, triamcinolone acetonide; PSM, propensity score matching; SMD, standardized mean difference; SH, stapled hemorrhoidopexy.

Table 4. Logistic regression analysis for predicting SHsS

SHsS, stapled hemorrhoidopexy site stricture; OR, odds ratio; CI, confidence interval; aOR, adjusted odds ratio; SH, stapled hemorrhoidopexy; TA, triamcinolone acetonide.

Table 5. Logistic regression analysis for predicting reoperation due to postoperative complications

OR, odds ratio; CI, confidence interval; aOR, adjusted odds ratio; SH, stapled hemorrhoidopexy; TA, triamcinolone acetonide.