The Italian Unitary Society of Colon-Proctology (Società Italiana Unitaria di Colonproctologia) guidelines for the management of acute and chronic hemorrhoidal disease
Authors: Brillantino Antonio , Renzi Adolfo , Talento Pasquale , Brusciano Luigi , Marano Luigi , Grillo Maurizio , Maglio Mauro Natale , Foroni Fabrizio , Palumbo Alessio , Sotelo Maria Laura Sandoval , Vicenzo Luciano , Lanza Michele , Frezza Giovanna , Antropoli Massimo , Gambardella Claudio , Monaco Luigi , Ferrante Ilaria , Izzo Domenico , Giordano Alfredo , Pinto Michele , Fantini Corrado , Gasparrini Marcello , Schiano Di Visconte Michele , Milazzo Francesca , Ferreri Giovanni , Braini Andrea , Cocozza Umberto , Pezzatini Massimo , Gianfreda Valeria , Di Leo Alberto , Landolfi Vincenzo , Favetta Umberto , Agradi Sergio , Marino Giovanni , Varriale Massimiliano , Mongardini Massimo , Pagano Claudio Eduardo Fernando Antonio , Contul Riccardo Brachet , Gallese Nando , Ucchino Giampiero , D’Ambra Michele , Rizzato Roberto , Sarzo Giacomo , Masci Bruno , Da Pozzo Francesca , Ascanelli Simona , Liguori Patrizia , Pezzolla Angela , Iacobellis Francesca , Boriani Erika , Cudazzo Eugenio , Babic Francesca , Geremia Carmelo , Bussotti Alessandro , Cicconi Mario , Sarno Antonia Di , Mongardini Federico Maria , Brescia Antonio , Lenisa Leonardo , Mistrangelo Massimiliano , Zuin Matteo , Mozzon Marta , Chiriatti Alessandro Paolo , Bottino Vincenzo , Ferronetti Antonio , Rispoli Corrado , Carbone Ludovico , Calabrò Giuseppe , Tirrò Antonino , de Vito Domenico , Ioia Giovanna , Lamanna Giovanni Luca , Asciore Lorenzo , Greco Ettore , Bianchi Pierluigi , D’Oriano Giuseppe , Stazi Alessandro , Antonacci Nicola , Renzo Raffaella Marina Di , Poto Gianmario Edoardo , Ferulano Giuseppe Paolo , Longo Antonio , Docimo Ludovico 
Published: August 2024

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.