Polidocanol Foam Enhances Recovery After Hemorrhoidectomy : Dis Colon Rectum | May 2026

Introduction

Hemorrhoids remain one of the most common anorectal disorders worldwide. For grade IV hemorrhoidal disease, the Milligan-Morgan Hemorrhoidectomy continues to be regarded as the surgical gold standard because of its durable efficacy. However, postoperative pain, bleeding and delayed return to normal activity remain major limitations. Polidocanol foam sclerotherapy has shown efficacy in lower-grade hemorrhoidal disease, but evidence supporting its adjunctive use in advanced grade IV disease has been limited.

Problem Statement

Despite excellent long-term control, conventional open hemorrhoidectomy is frequently associated with substantial postoperative morbidity and prolonged recovery. Whether adjunctive foam sclerotherapy can meaningfully improve postoperative recovery and symptom control after excisional surgery for advanced hemorrhoidal disease remains uncertain.

Summary

This randomized open-label single-center trial evaluated the addition of 3% polidocanol foam sclerotherapy to standard Milligan-Morgan hemorrhoidectomy in patients with grade IV hemorrhoidal disease. Thirty-six patients were randomized equally to combined therapy versus conventional surgery alone. The primary endpoint was recovery time measured by return to normal daily activity and work.

Patients receiving adjunctive polidocanol foam demonstrated significantly faster postoperative recovery, returning to normal activities nearly six days earlier than patients undergoing hemorrhoidectomy alone. Combined therapy was also associated with lower postoperative bleeding severity, reduced analgesic requirements and improved hemorrhoidal symptom scores during early postoperative follow-up. Importantly, no adverse events or continence deterioration were observed, and patient satisfaction remained high in both treatment groups.

The findings suggest that adjunctive foam sclerotherapy may reduce postoperative vascular congestion and inflammation following excisional hemorrhoidectomy, thereby improving early healing and reducing symptomatic recovery burden. The absence of increased complications is particularly notable given concerns regarding tissue necrosis or impaired wound healing with combined interventions.

Although limited by its small sample size, short follow-up duration and single-center nonblinded design, this study provides encouraging early evidence supporting integration of 3% polidocanol foam into surgical management strategies for advanced hemorrhoidal disease. Larger multicenter trials with long-term follow-up will be necessary to confirm durability, recurrence rates and broader reproducibility of these findings.