Title: Engineering Functional Preservation in Hemorrhoid Surgery: A Retrospective Evaluation of the 5PF Technique and Its Global Health Relevance
Abstract
Background: Hemorrhoids are a leading cause of surgical outpatient visits globally, yet they remain a neglected aspect of health systems planning. In this retrospective study, we present the 5PF (Precise, Purposeful, Predictable, Personalized, and Function-Preserving Fibrosis) technique, which redefines hemorrhoid surgery around the principles of functional preservation and anatomical integrity, particularly suited to resource-limited environments.
Methods: We evaluated 187 consecutive patients with grade III/IV hemorrhoids treated using 5PF at a 15-bed surgical center in India, with follow-up ranging from 1 to 13 years. The technique avoids resection and dressing, instead using controlled submucosal fibrosis to stabilize prolapse. Outcomes were categorized using clinical recurrence, complication severity, and recovery metrics.
Findings: No recurrence of prolapse, bleeding, stricture, or incontinence was observed. 100% of patients experienced bleeding/prolapse; constipation (78%), itching (31%), and pain (20%) were also common. Most patients (86%) were discharged within 24 hours. No reoperations, abscesses, or fistulas were reported. Postoperative complications were limited to manageable urinary retention (15%), prolonged reddish discharge (21%), pruritus, and minor skin tags. Pain resolved within 10 days in nearly all patients.
Interpretation: 5PF represents a shift from excision-based to architecture-preserving
approaches in benign anorectal disease. Its safety, reproducibility, and cost-effectiveness make it
relevant to the goals outlined in The Lancet Commission on Global Surgery. Prospective validation with standardized patient-reported outcomes and comparative trials is the next imperative.
Funding: No external funding was received.
Introduction
Hemorrhoidal disease contributes substantially to global surgical demand, yet treatment remains inconsistent and, in low-resource settings, largely unmet. Excisional hemorrhoidectomy, though effective, is associated with pain, delayed recovery, and functional risks such as incontinence or stricture. In LMICs, surgical access is limited and often delayed due to fear, stigma, or logistical barriers.
The Lancet Commission on Global Surgery emphasized the need for high-value, scalable solutions for common surgical problems. The 5PF technique was developed in response to these challenges: to provide a safe, teachable, and function-preserving alternative for high-volume benign anorectal disease.
Methods
This retrospective longitudinal study was conducted at a single surgical center with a dedicated practice in colorectal and oncologic surgery. Consecutive patients with grade III/IV internal and external hemorrhoids—including circumferential prolapse—were included. Patients were followed for a minimum of 12 months, with some tracked up to 13 years.
Surgical Technique: The 5PF method uses controlled fibrosis to reinforce prolapsed hemorrhoidal tissue. Key principles include:
Data Collection: Outcomes were assessed across three domains:
Results
Out of 187 patients (123 males, 64 females), all presented with prolapse and/or bleeding. Constipation (146), itching (57), and pain (38) were common. Key outcomes:
Discussion
The 5PF technique offers an architecture-preserving paradigm for hemorrhoid management. By avoiding excision and focusing on functional outcomes, it challenges the historical reliance on resective models. With no major complications and high patient satisfaction in a 13-year follow- up range, 5PF suggests recurrence is not inevitable but modifiable.
Its suitability for low-resource contexts stems from:
5PF aligns with priorities in global surgery, particularly for LMICs, where backlog of benign conditions demands locally relevant, cost-conscious, and high-safety interventions.
Limitations
Conclusion
The 5PF technique demonstrates encouraging outcomes and aligns with principles of equity, access, and anatomical function preservation. Its simplicity and reproducibility warrant global attention. Further validation is essential through multicenter studies, comparative trials, and integration into surgical training programs.
Acknowledgments The author acknowledges all patients who consented to long-term follow-up and video documentation.
Conflicts of Interest None declared.
References