This retrospective multicenter cohort study (HEAD-IBD, 2004–2024) evaluated the safety of hemorrhoidal surgery in 38 adults with IBD (21 UC, 17 CD), tracking surgical complications at 1, 6, and 12 months, IBD flares at 6 months, new-onset perianal disease, and continence outcomes over at least 12 months of follow-up.
Postoperative surgical complications occurred only in UC patients (5/21, 24%), were mostly mild, and zero complications were seen in CD patients at 30 days or 6 months. IBD flares within 6 months affected 6 patients (16%), split comparably between UC and CD. New-onset perianal disease arose in 5 patients (13%, mostly CD), and new-onset incontinence in 2 (5%), both managed conservatively.
Very small sample size (n=38) limits statistical power and generalizability. Retrospective design spanning 20 years introduces selection and ascertainment bias. A notable proportion of patients had clinically active IBD pre-operatively (24% UC, 41% CD), which may confound complication rates.
Hemorrhoidal surgery in IBD patients appears feasible with low morbidity, particularly in CD where no short-term surgical complications were observed. Clinicians should consider an individualized approach rather than a blanket contraindication, while closely monitoring for IBD flares and new perianal disease post-operatively.
