ArticleTechniques in coloproctology2022
Is the Goligher classification a valid tool in clinical practice and research for hemorrhoidal disease?
Article in Techniques in coloproctology, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT07427927 (Data-driven Clustering in Hemorrhoid Surgery), which is not on this map. Cited by 32 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Data-driven Clustering in Hemorrhoid Surgery: Retrospective Monocentric Study for the Identification of Clinical Phenotypes
Who cites it
32 citing papers in PubMed, 3 syntheses or guidelines pooled it, 47 citations in OpenAlex.
- Real-world use of polidocanol foam sclerotherapy for hemorrhoidal disease: insights from an international survey and systematic review with clinical practice recommendations.Updates in surgery · 2025Pooled it
- Limitations of the Goligher classification in randomized trials for hemorrhoidal disease: a qualitative systematic review of selection criteria.Techniques in coloproctology · 2025Pooled it
- Systematic review and meta-analysis of postoperative pain and symptoms control following laser haemorrhoidoplasty versus Milligan-Morgan haemorrhoidectomy for symptomatic haemorrhoids: a new standard.International journal of colorectal disease · 2022Pooled it
- Radiofrequency Ablation for Hemorrhoidal Disease.Life (Basel, Switzerland) · 2026Review
- Early hemodynamic changes following endoscopic sclerotherapy for hemorrhoidal disease assessed by transperineal ultrasound and their relationship with clinical outcomes.International journal of colorectal disease · 2026Observational
- Milligan-Morgan hemorrhoidectomy, mucopexy, and hybrid combination for grade III hemorrhoids: a large retrospective cohort study.Techniques in coloproctology · 2026Article
- Effectiveness and safety of 3% polidocanol foam sclerotherapy in hemorrhoidal disease: a multicenter, prospective study.International journal of colorectal disease · 2026Observational
- Evaluating the effectiveness of oral phlebotonics for the conservative management of hemorrhoidal disease: insights from the VIVI2022/01/VIVALDI study.Frontiers in surgery · 2026Article
- Comparative effectiveness and recurrence rates of endoscopic sclerotherapy, ligation, and combined therapy for grades I-III internal hemorrhoids.BMC surgery · 2025Article
- Arterial flow in healthy individuals and patients with hemorrhoidal disease: a Doppler ultrasound-based pathophysiological analysis.International journal of colorectal disease · 2025Observational
- [Hemorrhoidal disease and stage-dependent treatment (including anal prolapse)].Chirurgie (Heidelberg, Germany) · 2025Review
- Anatomical distribution of hemorrhoidal piles in advanced disease: clinical insights and correlations.Techniques in coloproctology · 2025Article
- The effect of endoscopic polidocanol carbon dioxide foam for internal hemorrhoids: a retrospective study.PeerJ · 2025Article
- Article
- Shifting Paradigms in Hemorrhoid Management: The Emergence and Impact of Cap-Assisted Endoscopic Sclerotherapy.Journal of clinical medicine · 2024Review
- An international observational study assessing conservative management in hemorrhoidal disease: results of CHORALIS (aCute HemORrhoidal disease evALuation International Study).Journal of comparative effectiveness research · 2024Observational
- Effectiveness of preoperative micronized purified flavonoid fraction treatment and sucralfate-based rectal ointment on hemorrhoidal disease: A case-matched analysis.Techniques in coloproctology · 2024Article
- Sclerotherapy with 3% polidocanol foam for the treatment of mucocutaneous bridges and/or residual piles after open excisional hemorrhoidectomy.Updates in surgery · 2024Article
- Treatment options for patients with pilonidal sinus disease: PITSTOP, a mixed-methods evaluation.Health technology assessment (Winchester, England) · 2024Observational
- Development and validation of the HDSIM™ assessment system: a measure of hemorrhoid disease symptom impact.Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation · 2024Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe most widely used classification for hemorrhoidal disease (HD) is the Goligher classification, which ranks presence and severity of prolapse in four grades. Since physicians base this gradation on medical history and physical examination, it might be prone to interobserver variability. Furthermore, the gradation impacts the treatment of choice which makes reproducibility of utmost importance. The aim of this study was to determine the interobserver variability of Goligher classification among surgeons in the Netherlands.
methodsA single-choice survey was used. The first part consisted of questions concerning baseline characteristics and the use of the Goligher classification in routine clinical practice. In the second part, to assess interobserver variability, we asked gastrointestinal surgeons and residents who routinely treat HD to review 25 photographs (with given timing as during rest or push) of patients with HD and classify the gradation using the Goligher classification. The survey was sent by email on April 19, 2021 and was available online until July 5, 2021. Interobserver variability was assessed using Fleiss' Kappa test.
resultsA total of 329 gastrointestinal surgeons, fellows and residents were sent an invitation email, of whom 95 (29%) completed the survey. Among the respondents, 87% indicated that they use the Goligher classification in clinical practice. Eighty-one percent found the classification helpful and 63% classified HD according to Goligher and followed the guidelines for treatment of HD accordingly. The interobserver variability showed an overall fair strength of agreement, with a Fleiss' Kappa (κ) of 0.376 (95% CI 0.373-0.380). There was a moderate agreement for grade I and IV HD with a κ statistic of 0.466 and 0.522, respectively. For grades II and III, there was a lower (fair) strength of agreement with 0.206 and 0.378, respectively.
conclusionsThe fair interobserver variability is disappointing and demonstrates the need for a more reliable, and internationally accepted, classification for HD. A new classification should enable more uniformity in treating HD and in comparing outcomes of future trials and prospective registries. The protocol for a Delphi study for a new classification system is currently being prepared and led by an international research group.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.