Taiwan society of colon and rectal surgeons' consensus on the management of hemorrhoidal disease.

BACKGROUND: Establishing statements backed by strong scientific evidence with the intention of standardizing and guiding Hemorrhoidal Disease (HD) diagnosis and treatment in both the general population and in specific patient groups is the aim of this consensus. METHODS: A consensus panel of 11 surgical specialists from the Taiwan Society of Colon and Rectal Surgeons was convened from July 2023 to October 2024. Using a modified Delphi methodology, the panel addressed the diagnosis, treatment, prevention, and special situations of HD. Experts responded to a pre-meeting survey, and a literature search of English-language studies on clinical judgment, pharmacologic treatments, and surgical interventions was conducted. Draft statements were developed, discussed, and refined during the first meeting in July 2023. In April 2024, the panel reviewed updated studies, finalized recommendations, and voted anonymously. An online meeting in October 2024 validated and approved the recommendations, which were graded using the GRADE system. RESULTS: A total of 9 consensus statements have been developed covering the diagnosis and management of HD. The general principle of this consensus statement is to follow most international guidelines. To tailor the local clinical practice, we also discussed the alternative treatment strategy for sclerotherapy, the use of traditional herbs/medicines, and the consideration of CRC screening test. CONCLUSIONS: These suggestions may represent a positive start toward recognized guidelines for improved hemorrhoidal disease treatment for all Taiwan healthcare professionals. As the first point of contact with patients, general practitioners, family medicine physicians, young surgeons, and pharmacists will find them to be quite valuable.