Surgical Management of Hemorrhoidal Disease in Inflammatory Bowel Disease. A Systematic Review with Proportional Meta-Analysis

Surgical treatment of hemorrhoidal disease (HD) in inflammatory bowel disease (IBD)
has been considered to be potentially harmful, but the evidence for this is poor. Therefore, a
systematic review of the literature was undertaken to reappraise the safety and effectiveness of
surgical treatments in this special circumstance. A MEDLINE, Web of Science, Scopus, and
Cochrane Library search was performed to retrieve studies reporting the outcomes of surgical
treatment of HD in patients with Crohn’s disease (CD) and ulcerative colitis (UC). From a total of
2072 citations, 10 retrospective studies including 222 (range, 2–70) patients were identified. Of these,
119 (54%) had CD and 103 (46%) UC. Mean age was between 41 and 49 years (range 14–77). Most
studies lacked information on the interval between surgery and the onset of complications.
Operative treatments included open or closed hemorrhoidectomy (n = 156 patients (70%)), rubber
band ligation (n = 39 (18%)), excision or incision of thrombosed hemorrhoid (n = 14 (6%)), and
doppler‐guided hemorrhoidal artery ligation (DG‐HAL, n = 13 (6%)). In total, 23 patients developed
a complication (pooled prevalence, 9%; (95%CI, 3–16%)), with a more than two‐fold higher rate in
patients with CD compared to UC (11% (5–16%) vs. 5% (0–13%), respectively). Despite the low
quality evidence, surgical management of HD in IBD and particularly in CD patients who have
failed nonoperative therapy should still be performed with caution and limited to inactive disease.
Further studies should determine whether advantages in terms of safety and effectiveness with the
use of non‐excisional techniques (e.g., DG‐HAL) can be obtained in this patient population.