Evidence map›Paper›PMID 40493094›Full record

SynthesisTechniques in coloproctology2025

Limitations of the Goligher classification in randomized trials for hemorrhoidal disease: a qualitative systematic review of selection criteria.

J Y van Oostendorp, U Grossi, I Hoxhaj, M L Kimman, S Z Kuiper, S O Breukink, I J M Han-Geurts, G Gallo

Registry-linked trialAbstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Techniques in coloproctology, 2025. 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 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from 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.

2 · The registry

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.

NCT07427927 enrolling by invitationnot on this map

Data-driven Clustering in Hemorrhoid Surgery: Retrospective Monocentric Study for the Identification of Clinical Phenotypes

TypeobservationalSponsorIRCCS Policlinico S. DonatoRan2024 to 2026Enrolled100ConditionsHemorrhoid, Hemorrhoid ProlapseArmsAny surgical procedure for hemorrhoidal disease
3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
  2. Article
  3. Observational
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

J Y van OostendorpDepartment of Surgery, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands.ORCID 0000-0002-2835-3997
U GrossiDepartment of Surgery, Oncology and Gastroenterology-DiSCOG, University of Padova, Padua, Italy. ugo.grossi@unipd.it.ORCID 0000-0001-5372-2873
I HoxhajDepartment of Surgery, Oncology and Gastroenterology-DiSCOG, University of Padova, Padua, Italy.ORCID 0000-0001-7086-2456
M L KimmanDepartment of Clinical Epidemiology and Medical Technology Assessment, Care and Public Health, Research Institute (CAPHRI), Maastricht University Medical Centre, Maastricht, The Netherlands.ORCID 0000-0002-5717-5704
S Z KuiperDepartment of Surgery, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands.ORCID 0000-0002-3587-7465
S O BreukinkDepartment of Surgery, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands.ORCID 0000-0002-5445-4011
I J M Han-Geurts *Department of Surgery, Proctos Kliniek, Bilthoven, The Netherlands.ORCID 0000-0001-5058-0574
G GalloDepartment of Surgery, Sapienza University of Rome, Rome, Italy.ORCID 0000-0003-1066-4671

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe diverse range of therapeutic options for hemorrhoidal disease (HD) highlights the need for precise classification systems to guide treatment. Although the Goligher classification remains the most widely used, it has been criticized for its simplicity and limited ability to capture symptom severity or guide treatment decisions. This study aims to evaluate the patient selection criteria and classification systems employed in randomized controlled trials (RCTs) for HD.

methodsA systematic review was conducted following the 2020 PRISMA guidelines. A comprehensive search of databases identified randomized controlled trials (RCTs) comparing treatments for HD, focusing on classification systems used for patient enrollment. Eligible studies included adult patients and at least one arm involving surgical treatment.

resultsOut of 6692 records, 162 studies met the inclusion criteria, with a median cohort size of 84 patients and 55.4% male. Most studies (86.4%) used the Goligher system, though the majority did not fully describe or cite the system. Only 13.6% of studies employed more recent alternative classification systems. The most common outcome measures across studies were postoperative pain (147 studies) and complications (133 studies). Recurrence rates were reported in 42% of studies, yet 70% of these did not provide adequate inclusion criteria or references to Goligher's classification.

conclusionsThe inconsistent application of the Goligher classification and the variability in patient selection criteria across RCTs highlight the need for more nuanced and standardized systems. Future research should focus on refining classification methods and incorporating patient-reported outcomes to improve the reliability and relevance of HD trials. PROSPERO REGISTRATION: CRD42023387339.

Indexed as

HemorrhoidsPatient SelectionRandomized Controlled Trials as TopicAdultFemaleHemorrhoidectomyHumansMaleMiddle AgedRecurrenceClassification systemsGoligher classificationHemorrhoidal diseaseHemorrhoidsPatient selectionRandomized controlled trials

Identifiers

PMID40493094
PMCPMC12152054

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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.