https://doi.org/10.46889/JSRP.2023.4106 https://athenaeumpub.com/journal-of-surgery-research-and-practice/ Research Article A Case Series of Large Volume Iii-Degree Hemorrhoidal Disease: A Special Anatomical Condition Requiring Surgical Treatment Sayali Valiyeva 1 , Paolo Cerri 2 , Simone Cicconi 2 , Antonio Pisciaroli 2 , Alfredo Torretta 2 , Renato Pietroletti 1* 1 Surgical Coloproctology, University of L’Aquila, Department of Clinical Medicine and Biotechnology, Hospital Val Vibrata, Sant’Omero (TE), Italy 2 Hospital Val Vibrata, Sant’Omero (TE), Italy *Correspondence author: Renato Pietroletti, Surgical Coloproctology, University of L’Aquila, Department of Clinical Medicine and Biotechnology, Hospital Val Vibrata, Sant’Omero (TE), Italy; Email: renato.pietroletti@univaq.it Abstract Background: Haemorrhoidal Disease (HD) is common and impacts negatively on quality of life with high socio-economic costs. Despite international guidelines aimed to indicate appropriate care in HD, treatment of III-degree HD remains controversial due to the wide range of ambulatory or surgical procedures available. We aimed to analyse treatment options for III-degree HD focusing on special cases characterized by large volume and/or circumferential presentation of intermittent prolapse or recurrence after conservative treatments. Methods: In the period January 2017- December 2018 out of 152 patients treated by excisional haemorrhoidectomy, we collected a case series of 29 patients affected by III-degree symptomatic HD. They showed a very large, single prolapse or circumferential one or failure of previous conservative treatments. Results: 14 (48.2%) patients (median age 45 yrs.) of our series were recurrence of HD following Rubber Band Ligation (RBL) (5pts), Dearterialization (DEART) (5pts), Stapled Haemorrhoidopexy (SH) (4pts). Mean operative time was 35 min. Postoperative severe pain (6.8%) and urinary retention (17.2%) were the main postoperative complications which did not affect the length of stay. All patients showed a good outcome without any complication at follow- up. Conclusion: III-degree HD shows the highest variability in anatomical presentation, and proposed treatment. Thus, the choice of a personalized approach must rely upon objective evaluation of volume of prolapse. Intermittent prolapse, if very large or circumferential, associated or not to large external haemorrhoids, makes a special condition III degree HD, suggesting surgical excision, avoiding conservative approaches. Keywords: III Degree; Haemorrhoidal Disease; Circumferential Prolapse; Large Prolapse; Haemorrhoidectomy Introduction The prevalence of Haemorrhoidal Disease (HD) in the general population is estimated to be 4.4%. In both sexes, a peak in prevalence is observed between 45 and 65 yrs. of age, with a subsequent decrease after age 65 yrs. The development of HD before age of 20 yrs. is unusual [1,2]. Constipation, a low fibre diet, a high Body Mass Index, pregnancy, and a sedentary lifestyle are assumed as risk factors of HD; however, evidence regarding these predisposing factors are controversial [3]. Conservative and surgical treatment of HD are well standardized and focused on the severity (grading) of disease as reported in different guidelines [4-6]. Citation: Pietroletti R, et al. A Case Series of Large Volume Iii-Degree Hemorrhoidal Disease: A Special Anatomical Condition Requiring Surgical Treatment. J Surg Res Prac. 2023;4(1):1-8. https://doi.org/10.46889/JSRP.2023. 4106 Received Date: 26-02-2023 Accepted Date: 24-03-2023 Published Date: 31-03-2023 Copyright: © 2023 by the authors. Submitted for possible open access publication under the terms and conditions of the Creative Commons Attribution (CCBY) license (https://creativecommons.org/li censes/by/4.0/).